Reduced medical abortion anxiety, stress with text messaging intervention

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1. In a randomized controlled trial, the use of a supportive text-messaging intervention was associated with decreased anxiety and stress among women undergoing medical abortions.

2. Women who received supportive text messages reported feeling more prepared for the side effects of their procedure and were nearly universally in favor of recommending the service to others.

Evidence Rating Level: 1 (Excellent)

Study Rundown: In a multi-site randomized controlled trial, researchers found that women who received a series of supportive text messages after undergoing medical abortion reported feeling more prepared and experiencing less stress and anxiety at home. Previous studies have demonstrated benefit with telemedicine interventions via internet or telephone contact for at-home abortion symptom management. This is the first study to look at the use of text messaging to offer guidance.

Strengths include the low cost and relative ease of implementation of the text intervention, which would allow for widespread access. Although it was a multi-centered trial, participants were more likely to have a higher level of education and were located in one urban area in South Africa, limiting generalizability of results. Future studies might evaluate this intervention using a multi-center study in both urban and rural communities in the United States to better characterize the pros and cons of such an intervention.

Click to read the study in Contraception

Relevant Reading: Provision of medical abortion using telemedicine in Brazil

In-Depth [randomized controlled trial]: Researchers randomized women undergoing early at-home medical abortion at four medical centers in Cape Town, South Africa to receive either standard of care (n=235) or standard of care plus timed, automated text messages between clinic visits that offered support and guidance (n=234). Women were interviewed at their initial clinic appointment and again at their 2-3 week follow-up appointment. Primary outcomes included anxiety and stress, assessed by verified surveys. Preparedness for abortion symptoms and overall satisfaction with the intervention were also assessed.

Compared with women receiving the standard of care, women who received the supportive text messages reported less anxiety (p=0.013), less emotional stress (p=0.015) and reported feeling more prepared for the bleeding (p<0.001) and pain (p=0.042) associated with pregnancy loss. Of the women who received the text messaging intervention, 99% would recommend the service to a friend.

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